Americans live in an era of technological wonders that couldn’t even be imagined generations ago.

The increasing power of computers puts all of the world’s information in the palm of a hand.

Nowhere are the changes more dramatic than in the medical field.

Heart operations are commonplace.

Hip and knee replacements are routine.

Americans generally are living longer with a better quality of life.

But few of these innovations have touched the delivery of health care. It’s still conducted on a 20th century model that costs too much for no better quality than other developed nations.

MICHAEL HOLAHAN/THE AUGUSTA CHRONICLETechnological innovations have made health care better so people are living longer, but paying for it is still stuck in the 20th century.

So when President Barack Obama rammed through his Affordable Care Act without a single Republican vote in Congress, it was doomed from the start.

Even the supporters of Obamacare admit that it did too little to control costs. While access was increased for about 20 million additional Americans, the bill eventually would be too great.

Of course, this is a complicated issue. Health now accounts for one-sixth of the economy. There is no single health care system in America, but four of them. T.R. Reid described them in his book, ‘The Healing of America.’

• The employer model: Most working Americans get their health insurance through their employer, a model that originated in World War II when wage and price controls prevented employers from giving wage increases. Most Americans are satisfied with this model and few have left their employers for Obamacare.

• The military model: This affects active-duty military through TriCare and veterans through the VA. It’s entirely government run. American Indians also receive health care through the government. The bureaucratic flaws, however, have been seen in the VA.

• The Medicare model: This affects those 65 and older as well as those on Social Security disability. Americans are generally satisfied with this model.

• The cash model: For working people without health insurance, this is where the crisis exists. Until Obamacare, they paid high retail prices for health care and were in danger of going into bankruptcy.

Obamacare changed everything. First, the pluses that even Republicans support:

• Allowing young people to remain on their parents’ policies until age 26. Since the young generally aren’t sick, this isn’t expensive.

• No more prohibitions on pre-existing conditions. This can get expensive for insurers unless there are enough healthy people to counter the expenses or revenue elsewhere.

• Insurers may no longer put caps on their yearly or lifetime coverage expenses for your essential health benefits. People shouldn’t go bankrupt over health care.

Nevertheless, Obamacare is failing as insurance.

Expenses are too high. Not enough young and healthy are joining. There aren’t enough choices for people. Major insurers are pulling out or pulling back.

In order to cut costs, insurers are limiting choices of physicians and plans, just like Medicaid or just like that hated three-letter abbreviation, HMO (Health Maintenance Organization).

Meanwhile, the choices that American consumers have elsewhere in their lives are not available in health care. It’s often too complicated.

And there often aren’t enough primary care doctors to help patients navigate the health care system.

There are a variety of good Republican plans in the mix such as the Better Way plan from Rep. Paul Ryan or the recently released plan from the Republican Study Group.

Here is what Americans can expect from the Republican president and Congress:
• More choices.
• Less government control.
• Access favored over guarantees.
• More individual responsibility.
• More simplicity, less complexity.

In the final analysis, as a former Mayo Clinic CEO in Jacksonville said, with health care, you can’t have it all.

You can have two of the following three:
• Lower cost
• High quality
• Universal access

Of these three, cost must come first, otherwise health care costs will squeeze the entire economy.

Until costs are addressed, the crisis will persist.

Mike Clark is the editorial page editor of ‘The Florida Times-Union’ in Jacksonville.

$6,400

THE AVERAGE DEDUCTIBLE FOR A FAMILY ON THE SILVER PLAN WITH OUT-OF-POCKET COSTSSource: New York Post

CHALLENGES

The Department of Health and Human Services announced last October that insurance plans offered under Obamacare would see premium increases of 25 percent on average – though the increases were much higher in some places, including Arizona where the increase was a whopping 116 percent.
News reports last year said a third of the country might be left with just one health insurer in their Obamacare exchange, as insurance companies bailed on the federal program.

OPPORTUNITIES

With a Republican Congress and White House, alternatives to Obamacare now have an opportunity to pass.
While preserving popular facets of the law, such as coverage for pre-existing conditions, more market-based and patient-centered approaches are bubbling up in Congress.
Republicans, who initially missed the health-care train leaving the station, now have an opportunity to put forth something that not only expands access and controls costs but also works.